What does this research mean for the field?

Subarachnoid hemorrhage can mimic acute coronary syndrome in out-of-hospital cardiac arrest, leading to misdiagnosis and increased mortality. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This research highlights the diagnostic challenge of distinguishing between subarachnoid hemorrhage and acute coronary syndrome in out-of-hospital cardiac arrest cases.

January 10, 2026International Journal of Emergency Medicine0 citationsOpen Access

When subarachnoid hemorrhage mimics acute coronary syndrome in out-of-hospital cardiac arrest: a diagnostic challenge

YLYoussef LahmouzMohammed V University JNJaouad NguadiMohammed V University HGHanae EL GhiatiMohammed V University

Key Result

Subarachnoid hemorrhage can mimic acute coronary syndrome in out-of-hospital cardiac arrest, leading to misdiagnosis and increased mortality.

Key Points

This research highlights the diagnostic challenge of distinguishing between subarachnoid hemorrhage and acute coronary syndrome in out-of-hospital cardiac arrest cases.
Case report of a 42-year-old woman with sudden cardiac arrest during exercise.
Monitoring of ECG and troponin levels to assess cardiac conditions.
Coronary angiography performed to evaluate for acute coronary syndrome.
Cranial CT used to diagnose subarachnoid hemorrhage after initial misdiagnosis.
Patient initially diagnosed with acute coronary syndrome based on ECG and elevated troponin levels.
Coronary angiography showed no blockages, confirming misdiagnosis.
Cranial CT revealed significant subarachnoid hemorrhage as the true cause.
Patient succumbed to complications from cerebral edema on day 5.

Structured PICO

Population

A 42-year-old woman with no cardiovascular risk factors who suffered sudden out-of-hospital cardiac arrest during exercise.

Subarachnoid hemorrhage can mimic acute coronary syndrome in out-of-hospital cardiac arrest, emphasizing the critical role of cranial CT in evaluating comatose post-arrest patients.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Out-of-hospital cardiac arrest (OHCA) is most often due to acute coronary syndrome (ACS), but less frequent causes like subarachnoid hemorrhage (SAH) may mimic cardiac disease through ECG changes and biomarker elevation, risking misdiagnosis and inappropriate interventions. The aim of this case was to present a case of a patient who experienced OHCA due to subarachnoid hemorrhage mimicking ACS leading to catastrophic results. A 42-year-old woman with no cardiovascular risk factors suffered sudden cardiac arrest during exercise. Initial ECG and troponin levels suggested SCA, but coronary angiography was normal. Subsequent head CT revealed a massive subarachnoid hemorrhage. Despite supportive care, the patient died on day 5 from cerebral edema. SAH can cause cardiac arrest with ECG changes mimicking ACS, highlighting the importance of cranial CT in comatose post–cardiac arrest patients.

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